Shedding Light on Sad

Winter is here, and while many welcome the holidays, a change in food, clothes, and possibly a difference in activity with the change in daylight, for some it can be a time that brings a change in mood that affects many aspects of daily life.

Seasonal affective disorder (SAD) is defined as an increase in depressed mood which correlates to the colder seasons of the year. The exact cause of SAD is unknown, but studies have found strong correlations to decreased serotonin levels in the brain. The exact causes for this reduction are not clear, but there are many theories. The most common correlation is between reduced sunlight exposure and lower serotonin levels. This would explain why the start of fall is such a common trigger with the change in hours and exposure to sunlight during the day, and why rates of SAD are reported more frequently in far northern and southern latitudes where days become markedly shorter in winter months or have little to no direct sunlight at all.

People who suffer from SAD often notice one or more of the following:

  • Increased irritability
  • Change in energy level
  • Over-reaction to daily stress
  • Increase in sleep, or difficulty getting out of bed
  • Appetite changes – craving for high carbohydrate or “comfort” foods
  • Increase in weight

How SAD impacts People with Diabetes

Interestingly, the amount of light exposure has also been linked to the development of type 1 diabetes. For people with diabetes, SAD can be the initiator for the perfect storm of impaired glucose management. Many healthy habits are set aside due to the change in mood and energy level.

Reduced activity may lead to reduced ability to process sugar and food. This can most often increase both blood sugar and weight. An increase in weight may lead to insulin resistance in which the body responds less to insulin.

A depressed mood can lead to a reduction in usual diabetes care behaviors. Those with diabetes may check their blood sugar less, forget to bolus for meals, exercise less or not at all, or crave more food. This increase in food intake, especially carbohydrates or comfort food, along with less movement maycause weight gain. It becomes a vicious cycle that is hard to break when you feel depressed and the issues compound one another: depression leads to reduced activity, increased Body Mass Index , reduced self-care which in turn makes us feel worse about ourselves.

For those with diabetes, this can lead to a deepening of depression that may already be present year-round. Rates of depression are nearly four times higher in persons diagnosed with diabetes than in the general population. Seeing our blood sugars increase and stay elevated only fuels those feelings. Diabetes burnout can also be fueled by the symptoms of SAD. And of course, let's not forget to add on that the most common time of year for SAD symptoms is also comfort food season! It seems like the moment the color of the leaves begins to change, candy / baked goods / holiday fare is everywhere we look!

Feeling Better

There are several treatments that have proven effective for treating SAD. For those with mild SAD, two low-risk treatments are often effective:

  1. Preemptive Behavioral Modification. This involves setting up a plan of good self-care habits (such as exercise) while the sun is still high in the sky to help reduce the impact of those darker months. Maintaining a well-balanced diet rich in nutrients from all the food groups can also help reduce cravings and reduce depression symptoms.
  1. Talk therapy has been shown to be one of the more effective and longest-lasting treatments for SAD. Consult your local mental health services for resources available in your area. Mental health is pivotal to maintaining good physical health, particularly for persons with diabetes.

Two other therapies have been shown to be clinically effective for people who suffer from persistent or more severe SAD symptoms:

  1. Selective Serotonin Reuptake Inhibitor (SSRI) Medications: These work by preventing what our bodies recognize as excess serotonin from being reabsorbed, which leaves more serotonin available to help regulate mood. Most SSRIs do not have a direct impact on blood sugar levels, though fluoxetine (brand name Prozac) can increase post hypoglycemic counter-regulatory blood sugars. Anyone using an SSRI for the first time should be in close contact with their prescriber and report any side effects immediately. SSRIs are not a one-size-fits-all, so it may take more than one medication and multiple adjustments to find the right dose and medication for you.
  1. Artificial Light Therapy. This has proven to be effective and is widely used in northern latitudes. In this form of treatment, one sits under a bright light (>10,000 lux) for 15-30 minutes every day, though morning use appears to be most effective. However, due to the brightness of the lamps used, caution is advised as eye damage could result. However studies have shown that in areas of only limited light reduction, such as the continental United States, simply increasing one's exposure to natural sunlight has the same effect. Try to take a mid-day walk when it is typically the warmest part of the day and the light is the brightest. This has been shown to have the same benefits as using an artificial light, and adds the extra benefits of physical activity.

As with any health condition, treatment will vary from person to person. It is important to not self-diagnose or treat SAD. The best plan is to discuss any symptoms with your doctor as well as the possible plan of action that might be best for you personally.

Written by Gary Scheiner, MS, CDE and the Integrated Diabetes Services clinical team